Organization
UNIVERSITY CHILDREN'S KIDNEY SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARD P. RABALAIS M.D. (CHAIRMAN)
(502) 852-8600
Entity
Organization
Contact information
Practice address
210 E GRAY STREET, STE. 1000, LOUISVILLE, KY 40202-3906
(502) 629-3972
(502) 629-3975
Mailing address
P.O. BOX 2469, LOUISVILLE, KY 40201-2469
(502) 852-8500
(502) 852-8556
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
—
—
2080P0210X
Pediatric Nephrology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200432180
—
IN
05
—
65939571
—
KY
Enumeration date
01/05/2007
Last updated
05/14/2012
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